TPN

Course Overview

Normal blood glucose levels are maintained through normal amounts of insulin secretion and normal sensitivity to insulin by the body’s tissues. Diabetes is characterized by chronic hyperglycemia which results from changes in metabolic status, which may be a combination of reduced insulin secretion and reduced glucose tolerance through insulin insensitivity. There are several different kinds of diabetes and each type can be specifically diagnosed and managed according to national guidelines for evidence-based practice. Appropriate diagnosis includes timing and specific indicators. Management efforts can include lifestyle changes and medications to prevent or minimize diabetes symptoms and complications of the disease and its treatments. Guidelines also include recommendations for reimbursement for particular diagnostic and management activities and products to improve patient care access and adherence. This course will review the basics of type 2 diabetes, including definitions, diagnosis, treatment options, and reimbursement issues.

Learning Objectives

Upon completion of this course the participant will be able to:

Describe the etiology of type 2 diabetes.
First, we will explore the causes of type 2 diabetes, looking specifically at genetic predisposition and metabolic disorders.
List three types of therapeutic options for type 2 diabetes. Options for patient self-care range from self monitoring of blood glucose to patient education and exercise. Medication therapies and clinical monitoring are factored in as well.
List three strategies to contain healthcare costs associated with diabetes care and treatment. There are a number of treatment strategies that can help to improve the patient's health, thereby minimizing their use of resources to manage the disease. By the conclusion of this course you should be able to describe three strategies which can help to contain costs.

Background Information

There are an estimated 26 million people living with diabetes in the United States (using 2010 estimates), representing 8.3% of the population.[i] Diabetes is the sixth leading cause of death in the United States. It is more prevalent in minority and older age populations. Diabetes is also a costly disease with an estimated $132 billion spent yearly on direct and indirect costs. Diabetes mellitus (DM) is a syndrome of symptoms and problems and is characterized by chronic hyperglycemia. It is related to metabolic disorders that affect the control of blood sugar levels. Type 1 diabetes represents about 5-10% of the population of patients with diabetes mellitus. Type 2 diabetes represents approximately 90-95% of all diabetes mellitus cases. Prediabetes mellitus may occur in an estimated 41 million people in the United States, which could dramatically increase the number of people living with diabetes if they do not receive early attention for diagnosis and treatment.

The risk for developing diabetes is growing. It was estimated that for people born in the year 2000, 33% of males and nearly 40% of females will develop diabetes at some point in the lives. Death rates for patients with diabetes are twice that for similar age groups and the average life expectancy is significantly reduced when diabetes is diagnosed before age 40. With the increase in obesity prevalence, particularly in groups at higher risk for other reasons, additional risk for diabetes is expected. About a third of adults are obese and another third are overweight.

Recently the American Association of Clinical Endocrinologists (the AACE), published guidelines for diabetes management.[ii] Diabetes has been classified as Type 1 diabetes mellitus, Type 2 diabetes mellitus, and other types of diabetes. Other types include those caused by genetic defects, exocrine pancreatic diseases, other conditions with hormonal alterations, infection and medication induced pancreatic and hormonal changes, immune-mediated diabetes, and other genetic conditions that have been associated with diabetes. In addition, gestational diabetes has its own classification.

[i] CDC. Fact Sheet: Number of Americans with diabetes continues to increase. Available at: http://www.cdc.gov/od/oc/media/pressrel/fs051026.htm.

[ii] AACE Diabetes Mellitus Clinical Practice Guidelines Task Force. Medical guidelines for clinical practice for the management of diabetes mellitus. Endocrine Practice. 2007;13(suppl 1):1-66. Available at: http://www.aace.com/pub/pdf/guidelines/DMGuidelines2007.pdf.